Topographical analysis of arterial perforators in the face: A cadaveric study

Abstract

Arterial perforators in the face are clinically significant in plastic surgery; however, comprehensive anatomical data are limited. The aim of this study was to investigate the number, diameter, and topographic distribution of arterial perforators in the face with a diameter of 0.5 mm or greater, regarded as clinically suitable donor vessels for flap transplantation. Seven cadavers (14 hemifaces; mean age, 80.3 years) were examined using micro-computed tomography combined with dissection. The number and average diameter at the origin of each perforator were recorded, and their locations were mapped based on the Frankfort horizontal plane and vertical line through the porion. A total of 134 perforators were identified in seven major arteries: the main trunk of the facial artery, submental artery, lateral nasal branch of the facial artery, transverse facial artery, anterior auricular branch of the superficial temporal artery, zygomaticoorbital artery, and frontal branch of the superficial temporal artery. The main trunk of the facial artery exhibited the greatest number of perforators (n = 47; prevalence, 100%; average per hemiface, 3.4) and the largest mean diameter (1.01 +/- 0.34 mm). In the heatmap of the perforator coordinates, the frontal branch of the superficial temporal artery demonstrated the widest dispersion, with a projected area of 22.7 cm(2). However, the lateral nasal branch of the facial artery exhibited the highest coordinate density at 4.8 per cm2. Perforators originating from the facial artery and transverse facial artery showed distinct distribution patterns relative to the horizontal line passing through the subnasale, suggesting that this line can be used as a reference in facial flap design. The comprehensive analysis of arterial perforators in the face conducted in this study provides quantitative and visualized data that may inform medical procedures of the face.